PATHOPHYS: URTIs

Question 1

What is otitis media?

Answer 1

Infection of the middle ear caused by viruses or bacteria.

Question 2

What are the important causative pathogens of otitismedia?

Answer 2

Strep pneumoniae
H. Flu
Moraxella catarrhalis
RSV
Coronavirus
Rhinovirus

Question 3

What is the most common predisposing factor to otitis media?

Answer 3

seasonal allergic rhinitis

Question 4

Who gets otitis media?

Answer 4

children under 3

Question 5

Why are young children most likely to develop otitis media?

Answer 5

they have small opening of the eustachian tube that is easily blocked by inflammation caused by viral infection/allergic response (which will cause fluid retention and infection in the middle ear)

Question 6

What are the physical findings of otitis media?

Answer 6

erythematous tympanic membrane with loss of light reflex and decreased mobility (sometimes tympanic membrane may bulge and rupture)

Question 7

HOw do you treat otitis media?

Answer 7

amoxicillin

Question 8

What is sinusitis?

Answer 8

inflammation of the paranasal sinuses

Question 9

What causes sinusitis?

Answer 9

impaired mucociliary clearance caused by viral infection or allergic rhinitis can obstruct the orifice of the sinus leading to mucus accumulation and bacterial overgrowth

Question 10

Which sinuses does sinusitis typically involve?

Answer 10

maxillary sinus (ostium of sinus is superior so mucus drainage has to go against gravity)

Question 11

What are symptoms of sinusitis?

Answer 11

Purulent nasal discharge
Nasal congestion
Facial/sinus pain
Fever

Question 12

What are the important pathogens of sinusitis?

Answer 12

S. pneumoniae
H. flu
M. Catarrhalis

Question 13

What is the treatment for sinusitis?

Answer 13

if symptoms last over ten-fourteen days, give amoxicillin (or augmentin if resistant)

Question 14

What is pharyngitis?

Answer 14

inflammation of the throat caused primarily by viruses (ex. adenovirus)

Question 15

What bacteria are involved in pharyngitis?

Answer 15

Strep pyogenes (GAS)
Neisseria gonorrhoeae (sexually)
Corynebacterium diptheriae (where no diptheria vaccine is given)
Mycoplasma, chlamydia, etc.

Question 16

What are the symptoms/signs of pharyngitis?

Answer 16

sore throat that is worse when swallowing
Fever
Inflamed pharynx, tonsils, and palate
Greyish exudate on tonsils
Lymphadenopathy (tender)
Petetchiae on palate

Question 17

How do you diagnose a GAS pharyngitis?

Answer 17

rapid antigen detection tests

Question 18

How do you treat GAS pharyngitis?

Answer 18

penicillin G, penicillin V, or amoxicillin

Erythromycin or cephalexin if penicillin allergy

Question 19

True or false: most sore throats are bacterial.

Answer 19

FALSE: most are viral, so prescribing antibiotics is a major problem!

Question 20

What is the common cold?

Answer 20

viral infection of the URI

Question 21

What types of viruses cause the common cold?

Answer 21

nonenveloped viruses like rhinovirus and coronavirus

Question 22

What may help to reduce symptoms of the common cold?

Answer 22

Zinc acetate in doses greater than 75 mg/day

Question 23

What is croup?

Answer 23

inflammation of the larynx, trachea, and large bronchi

Question 24

What is the key finding of croup?

Answer 24

inspiratory stridor

Barking cough

Question 25

What is the most common cause of croup?

Answer 25

parainfluenza virus RSV Flu

Question 26

What radiologic manifestation may indicate croup?

Answer 26

"steeple sign" which is subglottic tracheal narrowing

Question 27

What is the treatment of the croup?

Answer 27

corticosteroids (ex. dexmethasone) | with or without epinephrine

Question 28

What is laryngitis?

Answer 28

inflammation of the vocal cords of the larynx

Question 29

What are the common clinical manifestations of laryngitis?

Answer 29

hoarseness | aphonia

Question 30

What is the most common cause of laryngitis (top 2)?

Answer 30

parainfluenza virus | rhinovirus

Question 31

How do you treat laryngitis?

Answer 31

hydration | voice rest

Question 32

What is epiglottitis?

Answer 32

inflammation of the epiglottis

Question 33

What are the clinical manifestations of epiglottitis?

Answer 33

``` rapidly worsening sore throat odynophagia (pain swallowing) dysphagia (difficulty swallowing) muffled voice MEDICAL EMERGENCY for young children because may cause airway obstruction ```

Question 34

What is the most common cause of epiglottitis?

Answer 34

H. influenzae type B

Question 35

What is seen on indirect laryngoscopy of a patient with epiglottitis?

Answer 35

swollen, cherry red epiglottis

Question 36

What radiologic finding may be indicative of epiglottitis?

Answer 36

"thumb" sign (enlarged epiglottis)

Question 37

What is the treatment for epiglottitis?

Answer 37

IV ceftriaxone | maybe corticosteroids to reduce inflammation

Question 38

Is someone with a cold caused by rhinovirus at risk for pneumonia?

Answer 38

no Rhinovirus does NOT cause LRTI

Question 39

Is someone with a cold caused by coronavirus at risk for pneumonia?

Answer 39

NO coronavirus does not cause LRTI (unless it is SARS or MERS)

Question 40

Can rhinovirus survive in the GI tract?

Answer 40

NO--they are acid labile (killed by gastric acid when swallowed)

Question 41

Can coronavirus survive int he GI tract?

Answer 41

yes!

Question 42

Why do we not have a vaccine for rhinovirus?

Answer 42

because there are too many serotypes (over 100)

Question 43

How many serotypes are there for strep pneumo?

Answer 43

93

Question 44

What is the major pathogenesis of rhinovirus?

Answer 44

Chemical mediators of inflammation cause congestion and mucous secretion (LOOK BACK)

Question 45

What is a common complication of URTI?

Answer 45

acute bacterial sinusitis

Question 46

What is second line treatment for otitis media?

Answer 46

Augmentin

Question 47

How long do children get observed?

Answer 47

48-72 hours

Question 48

What is the pathogenesis of diptheria?

Answer 48

A-B toxin blocks protein synthesis by inactivating EF-2 by ADP ribosylation,resulting in decreased protein synthesis

Question 49

What is the pathogenesis for H. flu?

Answer 49

Produces IgA protease facilitating attachment to the mucosa, also is encapsulated and evades phagocytosis.

Question 50

What is the receptor for rhinovirus?

Answer 50

ICAM-1

Question 51

What is the most typical epidemiology for epiglottitis patient?

Answer 51

Urbanmale in his 40s with rapid onset of sore throat, muffled voice, and odynophagia/dysphagia

Question 52

Why are ear infections more common in children?

Answer 52

Ear infections are more common in children because their Eustachian tubes are shorter, narrower, and more horizontal than in adults.